小剂量去甲肾上腺素对蛛网膜下腔-硬膜外联合麻醉剖宫产术分娩新生儿影响

Effects of low-dose norepinephrine on neonates undergoing cesarean section under combined spinal-epidural anesthesia

目的探讨小剂量去甲肾上腺素(NE)对采取蛛网膜下腔-硬膜外联合麻醉(CSEA)下剖宫产术分娩新生儿氧摄取率(ERO_(2))及血气分析结果影响。方法选择2018年4月至2021年3月淮安市第一人民医院收治的98例拟采取CSEA剖宫产术产妇为研究对象。采用随机数字表法,将其分为研究组(n=49,麻醉穿刺成功后,采用微量泵静脉输注100μg NE)与对照组(n=49,麻醉穿刺成功后,不再给予任何血管活性药物)。采用回顾性分析方法,比较2组产妇及分娩新生儿以下指标。①产妇一般临床资料及手术情况(术中尿量、总输液量、出血量及追加NE产妇占比);②新生儿ERO_(2)与生后1 min Apgar评分及血气分析[动脉血二氧化碳分压(PaCO_(2))、脉搏血氧饱和度(SaO_(2))及动脉血氧分压(PaO_(2))];③产妇术中不良反应总体发生率;④新生儿加压给氧与气管插管治疗情况。本研究遵循的程序符合淮安市第一人民医院伦理委员会制定的伦理学标准,得到该委员会批准(伦审号:YX-2021-156-01),并于所有产妇签署临床研究知情同意书。结果①2组产妇分娩年龄、分娩孕龄、术前人体质量指数(BMI)等一般临床资料比较,差异均无统计学意义(P>0.05)。②2组产妇术中尿量、总输液量及出血量比较,差异均无统计学意义(P>0.05);对照组术中追加NE产妇占比低于研究组,并且差异有统计学意义(P<0.05)。③2组新生儿ERO_(2)、PaCO_(2)、SaO_(2)、PaO_(2)比较,差异均无统计学意义(P>0.05);后生1 min Apgar评分比较,差异亦无统计学意义(P>0.05)。④2组产妇术中不良反应总发生率比较,差异无统计学意义(P>0.05)。⑤2组新生儿均无需气管插管,研究组、对照组新生儿中,2例给予加压给氧治疗。2组新生儿加压给氧占比比较,差异无统计学意义(χ^(2)=0.71,P=0.399)。结论术前小剂量NE对CDSA剖宫产术分娩新生儿的氧摄取及血气分析无明显影响,但是可降低术中追加血管活性药物比例,并且安全可靠。

Objective To investigate effects of low-dose norepinephrine on the oxygen uptake rate(ERO_(2))and blood gas parameters of neonates undergoing cesarean section under combined spinal-epidural anesthesia(CSEA).Methods From April 2018 to March 2021,a total of 98 pregnant women who were admitted to Huai′an First People′s Hospital were selected in the study.They were divided into study group(n=49)and control group(n=49)by random number table.Both groups were treated with 6%hydroxyethyl starch(130/0.4)after opening the venous channel,and the pre-expansion time was 20 min at a drip rate of 10 mL/(kg·h).The control group did not use any vasoactive drugs after successful anesthesia puncture,and study group used a micro pump to infuse 100μg norepinephrine after successful anesthesia puncture,the infusion time was 1 min.Rapid increase in blood pressure within 1min after medication,with a shorter duration.By retrospective analysis,the following indexes of parturient and delivery newborn were compared between two groups.①The general conditions during the operation(intraoperative urine volume,total intraoperative fluid infusion volume,intraoperative blood loss,additional vasoactive drugs)were compared between two groups.②The ERO_(2),1 min Apgar score,blood gas parameters[partial pressure of carbon dioxide(PaCO_(2)),pulse oxygen saturation(SaO_(2))and partial pressure of oxygen(PaO_(2))]of two groups of newborns were compared.③The occurrence of adverse reactions were compared.④The conditions of neonatal pressurized oxygen and tracheal intubation were compared between the two groups.The procedure followed in this study conforms to the ethical standards formulated by the Ethics Committee of Huai′an First People′s Hospital and was approved by the Committee(Approval No.YX-2021-156-01).Informed consents were obtained from patients.Results①There were no significant differences in general clinical data such as delivery age,gestational age and preoperative body mass index(BMI)between two groups(P>0.05).②There were no statistically significant differences between two groups in the amount of urine,the total amount of intraoperative fluid infusion,and the amount of intraoperative blood loss between two groups(P>0.05).The proportion of additional vasoactive drugs in study group was lower than that in control group(P<0.05).③There were no significant differences in ERO_(2),PaCO_(2),SaO_(2),PaO_(2)between two groups(P>0.05).There were no significant differences in 1 min Apgar score after birth between two groups(P>0.05).④There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).⑤There was no need for tracheal intubation in two groups of newborns,and there was no significant difference in the number of neonatal pressurized oxygen administration between two groups(P>0.05).Conclusions Low-dose norepinephrine has no obvious effects on oxygen intake and blood gas parameters of newborns delivered by cesarean section under CDSA,which can reduce the proportion of vasoactive drugs,and is safe and reliable.